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Internal Medicine > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Mono typically causes what LAD?

A

Posterior cervical LAD

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2
Q

What is used to treat rosacea?

A

Metronidazole

Localized facial erythema with/without pustules and papules

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3
Q

Histoplasmosis presentations (mild to severe)

A

Mild: Pulmonary + mediastinal LAD
Severe: Hepatosplenomegaly with diffuse LAD

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4
Q

Vomiting after foodborne preformed toxin occurs when?

A

Within 6 hours (not 36 hrs)

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5
Q

Tinea versicolor treatment

A

Topical ketoconazole, terbinafine, selenium sulfide

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6
Q

Complications of malaria

A

Children - cerebral malaria: Seizure, coma, hypoglycemia, metabolic acidosis
Adults: Jaundice, acute renal failure, acute pulmonary edema

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7
Q

What are additional complications of Rocky Mountain spotted fever (RMSF)? What labs?

A

Encephalitis, pulmonary edema, bleeding, shock
Severe abdominal pain

Low platelets, hyponatremia, higher AST/ALT

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8
Q

Hidradenitis suppurativa - treatment

A

Mild: Topical clindamycin
Moderate: Oral tetracyclines
Severe: TNF-a inhibitors, oral retinoids, surgical excision

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9
Q

Asplenic adult patients should receive what vaccines? When should they receive them?

A

Pneumococcal (PCV20 or PCV15 + PPSV23); Hib (1 dose); Meningococcal (quad and sero B, q5years)

> =14d before or after the splenectomy

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10
Q

Candidemia - treatment

A
  1. Empiric antifungal (typically echinocandins first-line)
  2. Source control
  3. Evaluation for metastatic infection: ophthalmic, echocardiography
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11
Q

Utility of galactomannan, beta-D-glucan

A

Galactomannan: Aspergillus cell wall
Beta-D-glucan: sensitive (but not specific) for yeast infections

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12
Q

Organ transplant CMV affects which organ system most? Dx? Treatment?

A

GI - colitis/enteritis with multiple large shallow ulcers- fever, malaise, vomiting, bloody diarrhea, abdominal pain

Dx gold standard is biopsy of affected organ
Atypical lymphocytes on blood smear

Treat with ganciclovir and reduction of immunosuppression

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13
Q

Organ transplant herpes simplex-1 reactivation organ systems

A

Tracheobronchitis, esophagitis, pneumonia, and/or hepatitis

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14
Q

What is the most common cause of purulent pericaditis?

A

S. aureus from hematogenous spread; increased risk from chronic hemodialysis

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15
Q

Acute lymphangitis

A

Injection drug use inoculates skin flora into subcutaneous tissue

Sx: Tender red streaks up lymphatic channels with painful, swollen, erythematous regional lymphadnitis

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16
Q

Beta-D-glucan antigen

A

Rapid indicator of possible fungal infection (e.g. Candida)

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17
Q

Most common causes of catheter-related bloodstream infection (CRBSI)

A
  1. Coagulase-negative staph (e.g. S. epidermidis)
  2. S. aureus
  3. Enterococcus
  4. Candida

Draw 2 sets of blood cultures (1 from catheter, 1 from peripheral site) - differentiates contamination from true infection

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18
Q

Typical acute bacterial prostatitis antibiotics

A

E coli, Proteus:
1. Fluoroquinolone
2. Bactrim

Do this for 6 weeks

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19
Q

Echinococcus granulosus appears how on CT?

A

Thin-walled, septated lesions, occasionally with calcifications

Contracted from infected sheep or canines

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20
Q

Pulmonary histoplasmosis - chest x-ray

A

Healed granulomas (calcified)
Hilar lymphadenopathy

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21
Q

What virus can lead to toxic megacolon in immunocompromised patients?

A

CMV (cytomegalovirus colitis)

Treat with ganciclovir

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22
Q

Hydatid cyst appearance on CT; treatment

A

Large cyst with “eggshell” calcification, along with daughter cysts (internal septations)

Small cysts (<5 cm): Albendazole
Large cysts: Percutaneous therapy or surgery (watch for anaphylactic shock)

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23
Q

Cysticercosis - bug, location

A

Taenia solium

Cysts in brain or muscle

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24
Q

Uncomplicated parapneumonic effusion vs complicated vs empyema

A

Uncomplicated: Sterile exudate

Complicated: Bacterial invasion, moderate-large fluid, flowing or loculated, pH <7.2, glucose <60, WBC >50,000, LDH >1,000

Empyema: Frank pus in pleural space; bacteria positive on Gram stain

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25
Q
A
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26
Q

Which bacteria for most deep puncture wounds?

A
  1. S. aureus
  2. Pseudomonas
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27
Q

Antibiotics for anaerobic lung abscess

A

Zosyn
Carbapenem
Clindamycin (if beta-lactam allergy due to C diff risk)

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28
Q

Sydenham chorea - signs, tests

A

Chorea, hypotonia, behavioral changes
Motor and psychiatric symptoms tend to wax/wane
Disappear during sleep

Group A strep testing + antistreptolysin O and anti-DNAse B titers

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29
Q

What evaluation should all patients with bacterial meningitis receive before discharge?

A

Audiologic testing for hearing deficits - can result from inflammatory damage to cochlea

Cochlear ossification from fibrosis makes implantation surgery more difficult and outcomes poorer

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30
Q

Invasive pulmonary aspergillosis treatment

A

Voriconazole iv 1-2 weeks + caspofungin (an echinocandin), then prolonged oral voriconazole

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31
Q

Chikungunya - notable symptoms

A

Severe polyarthralgia (beginning in feet and hands) - Up to 70% develop chronic arthralgia/arthritis that lasts months/years - may require methotrexate

High fever, maculopapular rash, conjunctivitis

Lymphopenia, thrombocytopenia, transaminitis

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32
Q

Molluscum contagiosum treatments

A
  1. Cryotherapy
  2. Curettage
  3. Topical (eg cantharidin)
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33
Q

Type of infection based on time since transplant

A

<1 month: bacterial infection from surgery
1-6 months: opportunistic infections
>6 months: typical community acquired pathogens

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34
Q

Disseminated histoplasmosis treatment

A

IV amphotericin B (fungicidal) 1-2 weeks, then itraconazole (fungistatic) 1 year

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35
Q

JC virus on CT brain

A

Nonenhancing, asymmetric, white matter lessons without edema

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36
Q

Granuloma with narrow-based budding yeast

A

Histoplasmosis

(Coccidioidomycosis would be spherules with endospores, unilateral lung)

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37
Q

Candidal onychomycosis is least frequent in which part?

A

Toenails - most likely Trichophyton rubrum

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38
Q

High-dose iv acyclovir concerns

A

Poor urine solubility, crystal formation in renal tubules and AKI
Give iv fluids and loop diuretic to flush

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39
Q

When is clindamycin used in context of pulmonary ID?

A

Anaerobes or penicillin allergy with lung abscess or aspiration pneumonia

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40
Q

AIDS esophageal infection - organisms and management

A
  1. Candida - mild pain and concurrent oral thrush - oral fluconazole
  2. HSV - well-circumscribed lesions with round/ovoid, “volcano-like” appearance, and ballooning degeneration and eosinophilic intranuclear inclusions - acyclovir
  3. CMV - large, linear ulcerations in distal esophagus with intranuclear/intracytoplasmic inclusions - ganciclovir
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41
Q
A
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42
Q

Is HIV adenopathy painful or not?

A

Not painful, unlike mono

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43
Q

Rat-bite fever

A

Flu-like illness with diffuse maculopapular rash and arthralgia

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44
Q

Q fever

A

Tick-borne Coxiella burnetii, pleomorphic rod

Prolonged flu-like illness
Maculopapular rash

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45
Q

What else is transmitted by scratch besides Bartonella?

A

Pasteurella multocida - both are gram-negative coccobacilli

Bartonella causes papule and tender lymphadenopathy

Pasteurella causes cellulitis and lymphangitis

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46
Q

Tularemia vs others

A

Tularemia has ULCERATING papule with central eschar and tender regional lymphadenitis

Sporothrix may ulcerate but is not painful

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47
Q

Does Q fever produce lymphadenopathy?

A

No

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48
Q

Does rat bite fever cause lymphadenopathy?

A

No

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49
Q

Hep C - extrahepatic manifestations

A

Derm: Porphyria cutanea tarda, lichen planus
Renal: Membranoproliferative glomerulonephritis
Hematologic: Mixed cryoglobulinemia, ITP, AIHA

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50
Q

Isoniazid heme concern

A

Pyridoxine antagonist -> acquired sideroblastic anemia presenting as microcytic hypochromic anemia (dimorphic RBCs)

Unlike IDA, iron and TIBC may be normal or other direction

Give pyridoxine

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51
Q

Causes of false positive nontreponemal test

A

Pregnancy, HIV, IV drug use, liver disease, autoimmune

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52
Q

What infection can lead to toxic epidermal necrolysis

A

Mycoplasma pneumoniae

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53
Q

Bed bugs vs scabies

A

Bed bugs: linear tracks in exposed areas; palms not involved since skin too thick

Scabies: extensive excoriations and linear burrows, involves palm and web spaces, flexor wrists and extensor elbows, can develop pustules and wheals

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54
Q

Scabies treatment

A

5% permethrin or oral ivermectin

55
Q

Hyphae and yeast in spaghetti and meatballs pattern

A

KOH prep of tinea versicolor

56
Q

Tinea versicolor treatment

A

Topical ketoconazole, terbinafine, or selenium sulfide

Caused by Malassezia
Often hypopigmented if after sun exposure (which pathologizes this commensal bacteria) due to darkening of surrounding skin

57
Q

Sporothrix treatment

A

Prolonged itraconazole

58
Q

Cigar-shaped yeast with narrow-based budding at 37 C

A

Sporothrix, a dimorphic fungus from decaying plants/soil

59
Q

Whipple disease - manifestation

A

Chronic malabsorptive diarrhea (steatorrhea, flatulence, distention)
Protein-losing enteropathy
Weight loss
Migratory non-deforming arthritis
LAD
Low-grade fever

60
Q

Whipple disease - diagnosis

A

Small intestinal biopsy and PCR
PAS stain positive macrophages in lamina propria with non-acid-fast Gram+ bacilli

61
Q

Aspergillus appearance on X-ray

A

Cavitary mass with air crescents at periphery

62
Q

Infective endocarditis risk due to prosthetic valve, cardiac graft, or certain congenital cyanotic heart disease - which prophylactic antibiotics

A

Dental, respiratory: oral amoxicillin (reduce Strep viridans)
GU/GI procedure with active infection: oral amoxicillin (reduce Enterococcus)
SST procedure with active infection: IV vancomycin

63
Q

Erythematous edematous lesion -> bulla surrounded by erythema -> rupture -> painless ulcer with black center

A

Ecthyma gangrenosum = Pseudomonas

Often seen in immunocompromised state

64
Q

Who should not receive Varicella vaccine?

A

This is a live vaccine - do not give if CD4 <200

Zoster (shingles) vaccine, however, can be given to HIV patients

65
Q

Viral infection is more likely to cause what kind of cardiomyopathy?

A

Dilated cardiomyopathy

66
Q

Small hemorrhagic lesions on retina with white centers

A

Roth spots, highly suggestive of infective endocarditis

67
Q

Most common causes of osteomyelitis in SCD

A

Salmonella
S aureus

Otherwise, Strep pneumo is most likely to cause bacteremia/sepsis, often with no identifiable source

68
Q

Vesicles on posterior oropharynx

A

Herpangina from coxsackievirus A
Erythematous papules -> gray vesicles and ulcers

Coxsackie can also present as hand-foot-mouth disease with additional papules on palms and soles

Coxsackie can cause encephalitis

69
Q

Can impetigo cause rheumatic fever?

A

No, but it can cause APSGN

70
Q

CD4 counts for CMV, Cryptococcus, Toxoplasma

A

CMV: 50
Cryptococcus: 100
Toxoplasma: 100

71
Q

Vitamin A decreases morbidity/mortality of what infection?

A

Measles

72
Q

HHV-6 symptoms

A

Roseola - blanching maculopaular rash starting trunk then everywhere else; follows febrile phase

73
Q

Lyme arthritis (late manifestation) - characteristics

A

Large effusion but minimally painful, 10,000-25,000 leukocytes, negative Gram stain and culture

74
Q

Lyme arthritis (late manifestation) - characteristics

A

Large effusion but minimally painful, 10,000-25,000 leukocytes, negative Gram stain and culture

75
Q

Chlamydia arthritis vs Gonorrhea vs Lyme arthritis

A

Chlamydia is asymmetric oligoarthritis with urethral and eye manifestations
Gonorrhea starts with acute monoarthritis but becomes oligoarthralgia, quite painful, typically >25,000 leukocytes mostly neutrophils
Lyme is monoarticular, minimally painful arthritis, 10,000-25,000 leukocytes, negative Gram and culture

76
Q

Link the following infective endocarditis bugs:
S aureus
S epidermidis
Strep viridans
S Strep gallolyticus
Enterococcus
Fungi

A

S aureus - Prosthetic valves, catheters, implanted devices, IV drugs
S epidermidis - same but not IV drugs
Strep viridans (mutans, mitis, oralis, sanguinis) - Gingival manipulation, respiratory tract incision/biopsy
Strep gallolyticus - Colon cancer, IBD
Enterococcus - Nosocomial UTI
Fungi - Immunocompromised, IV catheter, prolonged antibiotics

77
Q

Lyme meningitis from dissemination is what predominance?

A

Lymphocytes

78
Q

Central hemorrhagic punctum bite

A

Bedbugs - confirmation requires visualization

79
Q

Where can Histoplasma disseminate?

A

Reticulonodular infiltrates with hilar or mediastinal LAD -> hepatosplenomegaly, LAD -> pancytopenia

Adrenal infiltration can occur in minority of cases

80
Q

C diff risk factors

A
  1. Antibiotics
  2. Hospitalization
  3. IBD
81
Q

Solitary vs multiple irregular, ring-enhancing lesion in brain of AIDS patient CD4 <50

A

Solitary: CNS lymphoma - EBV DNA in CSF basically confirms
Multiple: more likely toxoplasmosis

82
Q

Postherpetic neuralgia vs acute/subacute pain management

A

Acute (<=30days from rash) and subacute (30d - 3mo) - treat with NSAIDs, analgesics

Postherpetic (>3mo): treat with gabapentin, pregabalin, or TCAs

83
Q

Tinea appearance on microscopy

A

Branched, segmented hyphae

84
Q

Purpose of Wood’s lamp examination

A

Assess for microsporum infection in setting of tinea capitis

85
Q

Prophylaxis for possible Hep B exposure if titers low (anti-HBsAg titer <10) and no history of previous or current infection

A

HepB Ig and vaccine

86
Q

Do bed bugs affect genitalia?

A

No, typically only exposed areas
Corticosteroids can help with itching

87
Q

Why is Bactrim not used for Gram+?

A

High rates of Strep resistance

88
Q

What frequency of severe HSV requires daily antiviral?

A

> 6 outbreaks per year

89
Q

Impetigo treatment

A

Mild - mupirocin
Severe (non-MRSA) or ecthyma - oral cephalexin, dicloxacillin
Severe (MRSA) - clindamycin, doxycycline, bactrim
SSSS - nafcillin, vancomycin, wound care

90
Q

Small pink papules on trunk + fever, GI

A

Salmonella typhi - rose spots

91
Q

Erysipelas usually caused by… How does it differ from other cellulitis?

A

GAS; raised, indurated, well-demarcated

92
Q

Folliculitis resistant to therapy and intensely pruritic

A

Suspect eosinophilic folliculitis 2/2 AIDS; would need biopsy

93
Q

Isotretinoin requires what monitoring?

A

Elevates LFTs; teratogen

Liver function, cholesterol, triglycerides, baseline and serial pregnancy tests

94
Q

Are antibiotics needed for pilonidal cysts?

A

Not unless cellulitis - would need aerobic and anaerobic coverage

95
Q

Leprosy treatment

A

Tuberculoid: dapsone + rifampin
Lepromatous: add clofazimine

96
Q

C diff treatment for fulminant +/- ileus

A

PO vanc + parenteral metronidazole
Rectal vanc an option if ileus

97
Q

Echinococcus - treatment

A

Surgical resection of cysts and albendazole

98
Q

Entamoeba histolytica - treatment

A

Metronidazole

99
Q

Triad of myositis, periorbital edema, and eosinophilia

A

Trichinella spiralis - treat with albendazole (and steroids if severe)

100
Q

Ethambutol adverse effect

A

Optic neuritis

101
Q

Isoniazid adverse effects

A

Hepatitis
Peripheral neuropathy (give pyridoxine)

102
Q

MAC - treatment

A

Macrolide + ethambutol +/- rifabutin

103
Q

Anthrax treatment

A

Inhalational or head/neck areas: Ciprofloxacin or doxycycline + 1-2 additional antibiotics for at least 14 days

Other skin: 7-10 days

Postexposure prophylaxis woth ciprofloxacin for 60 days

104
Q

Organisms to worry about based on hand bite

A

Dogs and cats: Pasteurella, Staph, Strep
Human: Eikenella, GAS

105
Q

What antibiotics added for prosthetic IE?

A

+/- gentamicin, rifampin

Oxacillin or nafcillin for MSSA, vanc for MRSA

106
Q

What infection can cause Vit B12 deficiency?

A

Fish tapeworm, Diphyllobothrium latum

107
Q

Pupils constrict to accommodation but not light

A

Argyll Robertson pupils - tertiary syphilis

108
Q

Syphilis treatment if neurosyphilis confirmed from LP

A

IV penicillin x14 days (as opposed to IM x1 for early latent or IM weekly x3 for late latent)

109
Q

Klebsiella granulomatis - treatment

A

Azithromycin or doxycycline

110
Q

H ducreyi (chancroid) treatment

A

Azithromycin or ceftriaxone x1

111
Q

Lyme encephalitis vs RMSF or ehrlichiosis treatment

A

Lyme encephalitis is ceftriaxone; others are doxycycline

112
Q

What drug to avoid in HIV-associated dementia?

A

Efavirenz - due to CNS side effects

113
Q

Toxic shock syndrome treatment

A

MSSA: Clindamycin (for antitoxin properties) + nafcillin or oxcillin
MRSA: Clindamycin + vancomycin

114
Q

Primaquine - when to use for malaria

A

P ovale or P vivax infections, or unknown - eradicate hypnozoites in liver

115
Q

Does malaria cause rash?

A

No

116
Q

Mosquito-borne virus differential

A

All three of these have rash, fever, myalgia:
Chikungunya: joint pain
Dengue: bone pain, bleeding/shock
Zika: conjunctivitis, headache, GBS

117
Q

Lyme treatment; prophylaxis guidelines

A

Doxycycline, amoxicillin if pregnant, ceftriaxone if disseminated

Ppx: 1 dose doxycycline if tick >=36 hr, ppx <72 hr after removal, endemic >20%, and no contraindications

118
Q

Babesiosis vs Lyme

A

Intravascular hemolysis, jaundice, anemia
Maltese cross
IV azithromycin + atovaquone

119
Q

RMSF treatment

A

Doxycycline; if pregnant, chloramphenical during 1st two trimesters, otherwise doxycycline

120
Q

Ehrlichiosis vs other tick diseases

A

Headache, fever, chills, AMS, myalgia - but no rash
Use doxycycline

121
Q

Special HIV testing conditions

A

Early acute HIV: need combination test (HIV1/2 antibodies + p24) + viral RNA load (PCR-RNA)

Perinatal: Use NAAT to avoid confusion with maternal Ab

122
Q

Oval yeast cells in macrophages in HIV

A

Histoplasma

123
Q

Histoplasmosis ppx in HIV CD4 <150

A

Itraconazole

124
Q

Zidovudine - adverse effects

A

Bone marrow suppression, megaloblastic anemia

125
Q

One clinical scenario for efavirenz

A

NNRTI - doesn’t interfere with TB meds

Teratogenic, hepatotoxic, rash or SJS

126
Q

Maraviroc vs enfuvirtide

A

Maraviroc blocks gp120 docking protein
Enfuvirtide blocks gp41 fusion protein

127
Q

Boosting agents in HIV

A

Cobicistat and the protease inhibitors ritonavir, saquinavir

Inhibit CYP3A to increase drug levels of others

128
Q

Rabies post-exposure ppx

A

Previously immunized: vaccine only
Never immunized: vaccine + rabies Ig

129
Q

Partially acid-fast, filamentous, branching rods; pneumonia, brain abscess immunocompromised host

A

Nocardia

Treat with bactrim; add amikacin if disseminated; carbapenems if brain involved

130
Q

Pneumocystis treatment if sulfa allergy

A

Clindamycin + primaquine

131
Q

Cryptosporidium treatment in immunocompromised

A

Nitazoxanide

132
Q

Giardiasis treatment

A

Tinidazole or nitazoxanide
Children can use metronidazole as alternative
Paromomycin in 1st trimester

133
Q

Entamoeba treatment

A

Metronidazole or tinidazole + paromomycin

Internal Medicine (23 decks)

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